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		  <td colspan="4" align="center" bgcolor="#009966" style="color: #FFF">DATOS PERSONALES</td>
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		<tr align="left">
			<td width="217">Nombres:</td>
			<td><input name="nombres" type="text" class="required" minlength="2" tabindex="1"></td>
			<td width="176">Pais:</td>
			<td width="162"><select name="pais" id="pais"  tabindex="7">
			  				<option value="ARGENTINA">ARGENTINA</option>
				<option value="ALEMANIA">ALEMANIA</option>
				<option value="AUSTRALIA">AUSTRALIA</option>
				<option value="AUSTRIA">AUSTRIA</option>
				<option value="BELGICA">BELGICA</option>
				<option value="BOLIVIA">BOLIVIA</option>
				<option value="BRASIL">BRASIL</option>
				<option value="CANADA">CANADA</option>
				<option value="CHILE">CHILE</option>
				<option value="CHINA">CHINA</option>
				<option value="COLOMBIA">COLOMBIA</option>
				<option value="COREA">COREA</option>
				<option value="COSTA RICA">COSTA RICA</option>
				<option value="CROACIA">CROACIA</option>
				<option value="CUBA">CUBA</option>
				<option value="DINAMARCA">DINAMARCA</option>
				<option value="ECUADOR">ECUADOR</option>
				<option value="EL SALVADOR">EL SALVADOR</option>
				<option value="EMIRATOS ARABES UNIDOS">EMIRATOS ARABES UNIDOS</option>
				<option value="ESCOCIA">ESCOCIA</option>
				<option value="ESLOVAQUIA">ESLOVAQUIA</option>
				<option value="ESLOVENIA">ESLOVENIA</option>
				<option value="ESPAÑA">ESPAÑA</option>
				<option value="ESTADOS UNIDOS">ESTADOS UNIDOS</option>
				<option value="ESTONIA">ESTONIA</option>
				<option value="FINLANDIA">FINLANDIA</option>
				<option value="FRANCIA">FRANCIA</option>
				<option value="GRECIA">GRECIA</option>
				<option value="GUATEMALA">GUATEMALA</option>
				<option value="HOLANDA">HOLANDA</option>
				<option value="HONDURAS">HONDURAS</option>
				<option value="INDIA">INDIA</option>
				<option value="INGLATERRA">INGLATERRA</option>
				<option value="IRAN">IRAN</option>
				<option value="IRAQ">IRAQ</option>
				<option value="IRLANDA">IRLANDA</option>
				<option value="ISRAEL">ISRAEL</option>
				<option value="ITALIA">ITALIA</option>
				<option value="JAPON">JAPON</option>
				<option value="LETONIA">LETONIA</option>
				<option value="LITUANIA">LITUANIA</option>
				<option value="MEXICO">MEXICO</option>
				<option value="NICARAGUA">NICARAGUA</option>
				<option value="NORUEGA">NORUEGA</option>
				<option value="NUEVA ZELANDIA">NUEVA ZELANDIA</option>
				<option value="OTRO">OTRO</option>
				<option value="PANAMA">PANAMA</option>
				<option value="PARAGUAY">PARAGUAY</option>
				<option value="PERU">PERU</option>
				<option value="POLONIA">POLONIA</option>
				<option value="PORTUGAL">PORTUGAL</option>
				<option value="PUERTO RICO">PUERTO RICO</option>
				<option value="REPUBLICA DOMINICANA CENTRO AFRICANA">REPUBLICA DOMINICANA CENTRO AFRICANA</option>
				<option value="RUMANIA">RUMANIA</option>
				<option value="RUSIA">RUSIA</option>
				<option value="SINGAPUR">SINGAPUR</option>
				<option value="SUDAFRICA">SUDAFRICA</option>
				<option value="SUDAN">SUDAN</option>
				<option value="SUECIA">SUECIA</option>
				<option value="SUIZA">SUIZA</option>
				<option value="URUGUAY">URUGUAY</option>
				<option value="VENEZUELA">VENEZUELA</option>
				<option value="VIETNAN">VIETNAN</option>
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			<td>Apellidos:</td>
			<td><input name="apellidos" type="text" class="required" minlength="2" tabindex="2"></td>
			<td>Provincia:</td>
			<td id="provincia">&nbsp;</td>
			</tr>
		<tr align="left">
			<td>Tipo de Documento:</td>
			<td><select name="documento"  tabindex="3">
			  				<option value="DNI">DNI</option>
				<option value="CEDULA DE IDENTIDAD">CEDULA DE IDENTIDAD</option>
				<option value="LC">LC</option>
				<option value="LE">LE</option>
				<option value="OTRO">OTRO</option>
				<option value="PASAPORTE">PASAPORTE</option>
			  </select>
			  </td>
			<td>Correo Electronico:</td>
			<td><input name="email" type="text" id="email" class="required email" tabindex="9"></td>
			</tr>
		<tr align="left">
		  <td>Numero de Documento:</td>
		  <td><input name="numero_documento" type="text" class="required digits" minlength="8" maxlength="12"  tabindex="4"></td>
		  <td>Por Favor Reingrese su correo</td>
		  <td><input name="emailv" type="text" class="required email"  tabindex="10"></td>
		  </tr>
		<tr align="left">
		  <td>Telefono:</td>
		  <td><input name="telefono" type="text" class="digits" size="12" maxlength="12" minlength="8" tabindex="5"></td>
		  <td>Password para ingreso a curso:</td>
		  <td><input name="password"  type="password" id="password" class="required" size="12" maxlength="12" minlength="5" tabindex="11"></td>
		  </tr>
		<tr align="left">
		  <td>Celular:</td>
		  <td><input name="celular" type="text" class="digits" size="12" maxlength="12" minlength="8" tabindex="6"></td>
		  <td>Por Favor Reingrese password</td>
		  <td><input name="passwordv" type="password" class="required" size="12" maxlength="12" minlength="5"  tabindex="12"></td>
		  </tr>
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		  <td colspan="4" align="center">FORMACI&Oacute;N PROFESIONAL</td>
		  </tr>
		<tr align="left">
			<td>Profesion:</td>
			<td><input name="profesion" type="text" class="text" minlength="2"  tabindex="13"></td>
			<td>Actividad de la Empresa:</td>
			<td><select name="actividad" tabindex="17">
			  				<option value="AERONAVEGACION">AERONAVEGACION</option>
				<option value="AFJP">AFJP</option>
				<option value="AGRICULTURA Y GANADERIA">AGRICULTURA Y GANADERIA</option>
				<option value="AGROINDUSTRIA">AGROINDUSTRIA</option>
				<option value="ALIMENTOS Y BEBIDAS">ALIMENTOS Y BEBIDAS</option>
				<option value="ARQUITECTURA">ARQUITECTURA</option>
				<option value="ART">ART</option>
				<option value="ARTESANAL">ARTESANAL</option>
				<option value="ARTISTICA">ARTISTICA</option>
				<option value="ASOCIACION SIN FINES DE LUCRO">ASOCIACION SIN FINES DE LUCRO</option>
				<option value="ASTILLERO">ASTILLERO</option>
				<option value="AUTOMOTRIZ">AUTOMOTRIZ</option>
				<option value="BANCA / FINANCIERA">BANCA / FINANCIERA</option>
				<option value="BIENES DE CAPITAL">BIENES DE CAPITAL</option>
				<option value="BIOTECNOLOGIA">BIOTECNOLOGIA</option>
				<option value="CEREALERA">CEREALERA</option>
				<option value="COMERCIO">COMERCIO</option>
				<option value="COMERCIO EXTERIOR">COMERCIO EXTERIOR</option>
				<option value="CONGRESOS">CONGRESOS</option>
				<option value="CONSTRUCCION">CONSTRUCCION</option>
				<option value="CONSULTORIA / AUDITORIA">CONSULTORIA / AUDITORIA</option>
				<option value="CONSUMO MASIVO">CONSUMO MASIVO</option>
				<option value="CONTABILIDAD">CONTABILIDAD</option>
				<option value="CORREO">CORREO</option>
				<option value="COSMETICA">COSMETICA</option>
				<option value="CURTIEMBRE">CURTIEMBRE</option>
				<option value="DEFENSA">DEFENSA</option>
				<option value="DEPORTES">DEPORTES</option>
				<option value="DISCOGRAFIA">DISCOGRAFIA</option>
				<option value="DISEÑO">DISEÑO</option>
				<option value="ECOLOGIA">ECOLOGIA</option>
				<option value="EDITORIAL">EDITORIAL</option>
				<option value="EDUCACION">EDUCACION</option>
				<option value="ELECTRODOMESTICOS">ELECTRODOMESTICOS</option>
				<option value="ELECTRONICA">ELECTRONICA</option>
				<option value="ENERGIA">ENERGIA</option>
				<option value="ENTE REGULADOR">ENTE REGULADOR</option>
				<option value="ENTRETENIMIENTO">ENTRETENIMIENTO</option>
				<option value="ESCRIBANIA">ESCRIBANIA</option>
				<option value="FARMACEUTICA">FARMACEUTICA</option>
				<option value="FONDO DE INVERSION">FONDO DE INVERSION</option>
				<option value="FORESTAL">FORESTAL</option>
				<option value="FRIGORIFICO">FRIGORIFICO</option>
				<option value="GASTRONOMIA">GASTRONOMIA</option>
				<option value="GOBIERNO">GOBIERNO</option>
				<option value="GRAFICA">GRAFICA</option>
				<option value="HIGIENE Y PERFUMERIA">HIGIENE Y PERFUMERIA</option>
				<option value="HOLDING">HOLDING</option>
				<option value="HOTELERIA">HOTELERIA</option>
				<option value="IMPRENTA">IMPRENTA</option>
				<option value="INDUSTRIA">INDUSTRIA</option>
				<option value="INFORMACION E INVESTIGACION">INFORMACION E INVESTIGACION</option>
				<option value="INMOBILIARIA">INMOBILIARIA</option>
				<option value="INTERNET">INTERNET</option>
				<option value="JURIDICA">JURIDICA</option>
				<option value="LABORATORIO">LABORATORIO</option>
				<option value="MADERERA">MADERERA</option>
				<option value="MANOFACTURA">MANOFACTURA</option>
				<option value="MEDICINA PREPAGA">MEDICINA PREPAGA</option>
				<option value="MEDIOS">MEDIOS</option>
				<option value="METALMECANICA">METALMECANICA</option>
				<option value="METALURGICA">METALURGICA</option>
				<option value="MINERIA / PETROLEO /GAS">MINERIA / PETROLEO /GAS</option>
				<option value="MUEBLERIA">MUEBLERIA</option>
				option value="NAVIERA">NAVIERA</option>
				<option value="NEUMATICO / CAUCHO">NEUMATICO / CAUCHO</option>
				<option value="ORGANIZACIÓN INTERNACIONAL">ORGANIZACIÓN INTERNACIONAL</option>
				<option value="ORGANIZACIONES NO GUBERNAMENTALES">ORGANIZACIONES NO GUBERNAMENTALES</option>
				<option value="PAPELERA">PAPELERA</option>
				<option value="PESCA">PESCA</option>
				<option value="PETROQUIMICA">PETROQUIMICA</option>
				<option value="PINTURAS">PINTURAS</option>
				<option value="PLASTICOS">PLASTICOS</option>
				<option value="PODER JUDICIAL">PODER JUDICIAL</option>
				<option value="PRODUCTOS PARA LA CONSTRUCCION">PRODUCTOS PARA LA CONSTRUCCION</option>
				<option value="PUBLICIDAD / MARKETING / RRPP">PUBLICIDAD / MARKETING / RRPP</option>
				<option value="QUIMICA">QUIMICA</option>
				<option value="RETAIL">RETAIL</option>
				<option value="SALUD">SALUD</option>
				<option value="SEGURIDAD">SEGURIDAD</option>
				<option value="SEGUROS">SEGUROS</option>
				<option value="SERVICIOS">SERVICIOS</option>
				<option value="SERVICIOS PETROLEROS">SERVICIOS PETROLEROS</option>
				<option value="SERVICIOS PUBLICOS">SERVICIOS PUBLICOS</option>
				<option value="SIDERURGIA">SIDERURGIA</option>
				<option value="SUPERMERCADO / HIPERMERCADO">SUPERMERCADO / HIPERMERCADO</option>
				<option value="TABACALERA">TABACALERA</option>
				<option value="TECNOLOGIA">TECNOLOGIA</option>
				<option value="TELECOMUNICACIONES">TELECOMUNICACIONES</option>
				<option value="TEXTIL">TEXTIL</option>
				<option value="TRANSPORTADORA">TRANSPORTADORA</option>
				<option value="TRANSPORTE / LOGISTICA / DISTRIBUCION">TRANSPORTE / LOGISTICA / DISTRIBUCION</option>
				<option value="TURISMO">TURISMO</option>
				<option value="OTRA">OTRA</option>
			  </select></td>
			</tr>
		<tr align="left">
			<td>Nivel Educativo:</td>
			<td><select name="educacion_formal"  tabindex="14">
			  				<option value="DOCTORADO">DOCTORADO</option>
				<option value="MBA">MBA</option>
				<option value="MASTER">MASTER</option>
				<option value="POSTGRADO">POSTGRADO</option>
				<option value="UNIVERSITARIO">UNIVERSITARIO</option>
				<option value="TERCIARIO">TERCIARIO</option>
				<option value="SECUNDARIO">SECUNDARIO</option>
				<option value="OTRO">OTRO</option>
			  </select>
			  </td>
			<td>Cargo:</td>
			<td><select name="cargo"  tabindex="18">
			  				<option value="GERENCIA / ALTA GERENCIA / DIRECCION">GERENCIA / ALTA GERENCIA / DIRECCION</option>
				<option value="JEFE / SUPERVISOR / RESPONSABLE">JEFE / SUPERVISOR / RESPONSABLE</option>
				<option value="SENIOR / SEMI-SENIOR">SENIOR / SEMI-SENIOR</option>
				<option value="JUNIOR">JUNIOR</option>
				<option value="OTROS">OTROS</option>
			  </select></td>
			</tr>
		<tr align="left">
			<td>Titulo Obtenido:</td>
			<td><input name="titulo" type="text" class="text" minlength="2" tabindex="15"></td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			</tr>
		<tr align="left">
			<td>Empresa/Institucion a la que pertenece:</td>
			<td width="183"><input name="entidad" type="text" class="text" minlength="2" tabindex="16"></td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr bgcolor="#009966" style="color: #FFF">
		  <td colspan="4" align="center">CONDICIONES DEL CURSO VIRTUAL</td>
		  </tr>
		<tr>
		  <td colspan="4"><a class="condi" href="pdf/Condiciones.pdf" target="_blank"><strong>::</strong> Ver terminos y condiciones de Curso Virtual de BPM <strong>::</strong></a></td>
		  </tr>
		<tr>
		  <td colspan="4">He leido y acepto los terminos y condiciones del Curso Virtual de BPM
		    <input name="aceptar" type="checkbox" id="aceptar" class="required">
		    </td>
		  </tr>
		<tr>
		  <td colspan="4">&nbsp;</td>
		  </tr>
		<tr>
		  <td colspan="4"><input name="enviar" type="submit" value="Enviar">
            <input name="borrar" type="reset" value="Borrar">
            <input name="button" type="button" onClick="history.back(-1)" value=" Volver"></td>
		  </tr>
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